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. 2019 Jan 8;3(1):12-20.
doi: 10.1182/bloodadvances.2018028241.

Burden and impact of multifactorial geriatric syndromes in allogeneic hematopoietic cell transplantation for older adults

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Burden and impact of multifactorial geriatric syndromes in allogeneic hematopoietic cell transplantation for older adults

Richard J Lin et al. Blood Adv. .

Abstract

Multifactorial geriatric syndromes are highly prevalent in older patients with cancer. Because an increasing number of older patients undergo allogeneic hematopoietic stem cell transplantation (allo-HCT), we examined the incidence and impact of transplant-related geriatric syndromes using our institutional database and electronic medical records. We identified 527 patients age 60 years or older who had undergone first allo-HCT from 2001 to 2016 for hematologic malignancies. From the initiation of conditioning to 100 days posttransplant, new geriatric syndromes were predominantly delirium with a cumulative incidence of 21% (95% confidence interval [CI], 18%-25%) at day 100 followed by fall at 7% (95% CI, 5%-9%). In multivariable analyses of available pretransplant variables, fall within the last year, potentially inappropriate use of medication, thrombocytopenia, and reduced creatinine clearance were significantly associated with delirium; age older than 70 years and impaired activities of daily living were significantly associated with fall. In the 100-day landmark analysis, both delirium (hazard ratio [HR], 1.66; 95% CI, 1.09-2.52; P = .023) and fall (HR, 2.14; 95% CI, 1.16-3.95; P = .026) were significantly associated with increased nonrelapse mortality; moreover, fall (HR, 1.93; 95% CI, 1.18-3.14; P = .016), but not delirium, was significantly associated with reduced overall survival. Here, we establish baseline incidences and risk factors of common transplant-related geriatric syndromes. Importantly, we demonstrate significant associations of delirium and fall with inferior transplant outcomes. The burden and impact of transplant-related geriatric syndromes warrant the institution of patient-centered, preemptive, longitudinal, and multidisciplinary interventions to improve outcomes for older allo-HCT patients.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Outcomes of allo-HCT in older adults and the prevalence of transplant-related geriatric syndromes. (A) Estimates of OS and PFS of the cohort using the Kaplan-Meier method. (B) Estimates of cumulative incidences of NRM and relapse/disease progression using the cumulative incidence method. (C) Estimates of cumulative incidences of delirium and fall using the cumulative incidence method.
Figure 2.
Figure 2.
Impacts of delirium and fall on transplant outcomes. (A) The significant association of delirium with increased incidence of NRM using a landmark analysis at 100 days. (B) The significant association of fall with increased incidence of NRM using a landmark analysis at 100 days. (C) The nonsignificant association of delirium with reduced OS using a landmark analysis at 100 days. (D) The significant association of fall with reduced OS using a landmark analysis at 100 days.
Figure 3.
Figure 3.
Possible etiologies of delirium and fall. (A) Causes of delirium (%) identified by the primary transplantation team. (B) Causes of fall (%) identified by the primary transplantation team.

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